FATTY DEGENERATION OF THE HEART. 



375 



CHAPTER X. 



DEGENERATION OF THE SUBSTANCE OF THE HEART, GROWTHS, 

 PARASITES. 



ETIOLOGY AND PATHOLOGICAL ANATOMY. 1. An abnormal soft- 

 ness, relaxation, and flabbiness of the substance of the heart, impart- 

 ing to it "a parboiled look " (JRoJcitansky), are not uncommon in the 

 bodies of those who have died of typhus, septicaemia, puerperal fever, 

 etc. No important alteration can be detected in its structure, and we 

 must beware of mistaking the relaxation resulting from decomposition 

 for that which has taken place during life. The state of other organs 

 must form our criterion in this case. 



2. Fatty Heart must be regarded as of two kinds : 



a. Increase of the amount of fat normally found upon the surface 

 of the heart. 



b. Fatty metamorphosis of the primitive fasciculi of the muscular 

 substance. 



In the former we find a layer of fat, half an inch thick, covering 

 the heart, particularly along the course of the coronary arteries, upon 

 its edges, and in the sulcus between the two chambers. Beneath this 

 fatty layer the muscle is either normal or has undergone atrophy and 

 thinning from pressure of the superimposed fat. In many cases, atro- 

 phy of the muscle occurs while the fat-tissue is forming, and with- 

 out the growth of the latter having become very remarkable. This 

 growth, then, takes place at the expense of the substance of the heart, 

 so that a cardiac wall of normal thickness may at last consist only of 

 adipose tissue. This excessive production of fat in the heart often 

 accompanies general obesity, especially that of advanced age, and in 

 subjects otherwise healthy. It is also seen, however, in cancer, and 

 in other, cachexia, and especially among drunkards. 



Fatty metamorphosis of the primitive fasciculi consists in conver- 

 sion of the fibrillae into fat-granules, which gradually fill the entire 

 sarcolemma, and afterward combine to form large drops. Thus the 

 substance of the heart becomes discolored, and is converted into a pale- 

 yellowish mass which tears readily. Sometimes the metamorphosis 

 pervades large tracts of the organ, while in other cases particular 

 parts only are affected, as, for instance, the papillary muscles. Accom- 

 panied by arcus senilis, and fatty degeneration of the arteries, it ofter* 

 forms one of the signs of marasmus senilis, or of other marasmic states, 

 which arise in cancer, Bright's disease, etc. Ossification of the cor- 

 onary arteries, pressure of pericardial exudation, or even that accu- 

 mulation of fat upon the surface of the heart just mentioned, may give 



